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Study Guidefor theCERTIFIED CLINICALNUTRITIONIST (CCN)EXAMINATIONPrepared by:Clinical Nutrition Certification Board400 Chisholm Place #303Plano, TX 750752019 CNCB. All rights reservedPage 1

TABLE OF CONTENTSThe Development of an ExaminationConstructing a Content-Valid ExaminationRole DelineationConstruction of the Test BlueprintItem Development and ValidationAnalysis of Test ItemsExamination DevelopmentExamination Review and RevisionSummary and Conclusions333344445Documentation Explanation5The ExaminationMajor Categories of the ExaminationSpecific Breakdown of Examination Content555List of Reference Books for Exam8Sample QuestionsAnswer Key for Sample Questions910Code of Professional Ethics and Responsibility112019 CNCB. All rights reservedPage 2

The Development of an ExaminationConstructing a Content-Valid ExaminationThe development of a valid examination begins with a clear and concise definition of the knowledge, skills, andabilities needed for competent job performance. Using interviews, surveys, observation, and group discussions, CASworked with experts in the field of clinical nutrition to delineate critical job components. This analysis (the RoleDelineation) determines test content. In addition, throughout the examination construction process, The CNCBScientific Council maintains constant validity checks, thus assuring that the examinations produced are valid andreliable measures of the content knowledge and abilities required for one to function as a competent ClinicalNutritionist.The Diagram below lists each of the steps involved in constructing a content-valid examination.Role Delineation* Construction of a Test Blueprint* Item Development and Validation* Analysis ofTest Items* Examination Development* Review and Revision* Cut Score* Content-Valid Exam Role DelineationTo realize the CNCB’s commitment to developing a valid examination for its certification examination, CAS askedexpert clinical practitioners to clearly and concisely define the knowledge, skills, and abilities that are the keystones ofthe profession. Using surveys, observation, and group discussions, CAS conducted the first Role Delineation study forthe CNCB to obtain such a definition and to identify critical job components. The Role Delineation study ensures thatthe CCN examination measures the knowledge and skills required to be a Clinical Nutritionist. The results of the RoleDelineation study are analyzed and incorporated into the CCN Certification Examination.The following chart illustrates how major job components (“Performance Domains”) are organized into tasks,knowledge areas, and skills.The Hierarchical Arrangement of Components in a Role Delineation StudyProfession* Performance Domains* Knowledge Areas and Skills**The following are examples of major Performance Domains taken from the Role Delineation study for CNCB.1.Optimal Human Nutrition – PGSCN Session ICovers Basic Knowledge Related to Nutrition2.Human and Cognition Overload – PGSCN Session IICovers Nutrition Assessment and Evaluation3.Detoxification, Herbology & Homeo pathic Therapy– PGSCN Session III4.Laboratory Assessment – PGSCN Session IVUsing the Role Delineation study, the CNCB Scientific Council sends a Validation Survey to randomly chosenprofessionals in the field of clinical nutrition. The survey asks these professionals to rate the importance and potentialharm of each of the major Performance Domains as well as to predict the percentage of time devoted to it in the normalperformance of job responsibilities. Construction of the Test BlueprintIn the next step, the results from both the Role Delineation study and the Validation Survey are used to construct a“blueprint” or a plan for the certification examination. Item Development and ValidationThe next stage in the development of the CCN Certification Examination is to develop items, or questions, that pertainto the areas of performance outlined in the test blueprint. With the help of content area experts, the Scientific Councildevelops psychometrically-valid test items. Stringent criteria are used by experts in developing and evaluating items.The content of each item must be well-documented and represent current best practice. Items must be clearly written2019 CNCB. All rights reservedPage 3

and easily understood. Experts also classify items according to content area and cognitive level.Three formal Item Validity Rating Scales are used to finalize test items. In order to be accepted, an item must bejudged relevant to certification level performance. It also must be judged to tap knowledge critical in differentiatingadequate from inadequate job performance. Finally, experts must judge that inadequate mastery of the knowledgecovered in the items could result in performance errors that could cause harm. In addition to these validity scales,expert judges also review each item to assure that the correct answer has been accurately identified, that it does notdiscriminate against one group of examinees or another, and that all distractors (incorrect options) are plausible, butindeed wrong. The difficulty level of the item is also rated. Analysis of the Test ItemsCNCB Scientific Council collects statistics about the performance of CCN Certification Examination questions as theyare used on the examination. Referred to as item analysis, CNCB Scientific Council evaluates the difficulty of th equestion, the degree to which the question discriminates between knowledgeable and unknowledgeable candidates, andthe effectiveness of incorrect response option relative to the correct answer.Item analysis information plays a central role in revising questions and selecting questions of the highest quality whennew versions of the examination are created. In this manner a test can be built to correspond to a specified difficultylevel and to a desire level of reliability. Examination DevelopmentEach version of the exam is created by randomly selecting the appropriate number of items from each content area, asspecified in the test blueprint. The items are then incorporated into a preliminary examination, and this examination isreviewed by members of the CNCB knowledgeable about each content area for any duplication of items to evaluatewhether any items may cause unforeseen problems. In essence, the item is again evaluated in terms of howpsychometrically sound, fair, and content-valid it is with respect to the whole examination. Examination Review and RevisionAs part of the item development procedures, the content area covered by each item is identified. When a new versionof an examination is needed, a preliminary version is created by randomly selecting the appropriate number of itemsfrom each item pool for each content area, as specified in the test blueprint.This preliminary version of a certification examination is then subjected to the scrutiny of content area experts. First,the entire examination is reviewed to identify items that are duplicates or that may present a problem. Second, eventhough each item has already been judged to be psychometrically sound, fair and content-valid, the same process usedto screen items for the item pool is repeated by a second group of content experts. As in the development of the itempool, the content area experts must reach a consensus concerning the acceptability of each item. The use of ItemValidity Rating Scales a second time provides further support for the acceptability of the item and documentation of itsvalidity.Following this, each item that has passed both the item development and test development review is reviewed a thirdand final time. Again, content area judges evaluate the validity, appropriateness for entry-level personnel, andcorrectness of each item.At this point a final version of the examination has been developed. However, further safeguards are also built into thewritten examination to assure that certification candidates receive a content-valid examination. When examining agroup of candidates’ responses to one version of the certification examination, any items that might appear to bequestionable could then be excluded. To elaborate, despite the rigorous screening procedures, any item may beconfusing to entry-level candidates that was not confusing to the expert judges. An indicator of this confusion could bethat a large number of examinees’ scores on that item might be dropped from the total score.2019 CNCB. All rights reservedPage 4

Summary and ConclusionsThe procedures used to develop the CCN Examination are accepted procedures for developing fair and content-validexaminations. Each step in the test construction process, from Role Delineation to acceptance of the final version of anexamination, is carefully documented. Through multiple reviews by content and psychometric experts and the use ofstringent criteria, the validity of each step in the test construction process is assured.The Examination InstructionsThe questions on the CCN Examination are multiple-choice. The actual exam contains 150 questions with only onecorrect choice out of the five for each question. Carefully read each question and all of the choices before making aselection. You will have three hours to complete the exam.When you take the exam, be sure to mark only one answer for each question, as questions with more than one choiceselected will not count toward your final score.You are advised to answer every question, since your final score will be determined by the total number of correctanswers. There is no penalty for guessing. Major Categories of the ExaminationPERFORMANCE DOMAINI.Optimal Human NutritionII.Cognition & Sensory OverloadIII.Detoxification, Herbology and HomeopathicTherapyIV.Laboratory AssessmentTotal Number of ItemsNumber of Questions35325528150 Specific Breakdown of Examination ContentPERFORMANCE DOMAIN I: OPTIMAL HUMAN NUTRITION - PGSCN SESSION IKnowledges: Knowledge of the biochemistry of Essential Vitamins.Knowledge of the biochemistry of Essential Minerals.Knowledge of the biochemistry of Essential Trace MineralsKnowledge of the biochemistry of Essential Amino Acids & Accessory NutrientsKnowledge of Optimal Human NutritionKnowledge of Environmental Health IssuesKnowledge of Drug Induced Nutritional Deficiencies2019 CNCB. All rights reservedPage 5

PERFORMANCE DOMAIN II: COGNITION AND SENSORY OVERLOAD - PGSCN SESSION IIKnowledges: Knowledge of Free Radicals and AntioxidantsKnowledge of the Biochemistry of Fats and Oils.Knowledge of client/patient selection techniques.Knowledge of the Human MicrofloraKnowledge of Cognitive Enhancing Drugs & NutrientsKnowledge of Alternative Cancer Therapies.Knowledge of Women’s Health Conditions.Knowledge of Cardiovascular Disease.Knowledge of Hyperinsulinemia.Knowledge of Allergies and Asthma.Knowledge of ADD and ADHD.Knowledge of Assessment & Medical Symptom Questionnaires.EXAM TEXT BOOK STUDYAdrenal Fatigue: The 21st Century Stress Syndrome. Publisher: Smart Publications / 2001 Wilson Basic knowledge of digestive and absorptive functions.Knowledge of specific, naturally-occurring compounds in foodstuffs and their actions (e.g., bioflavonoids).Knowledge of effects of chemical pollution of air, water, food, etc. on nutritional status.Knowledge of client’s/patient’s chief complaints and current symptoms.Knowledge of saliva tests.Knowledge of other diagnostic tests (i.e., radiographs) related to nutritional assessment.Knowledge of physical signs of abnormal endocrine and neurologic functions.Knowledge of the impact of different food types on various illness states.Skill in instructing the client as to how his or her body responds biochemically and physiologically.Recommend to the client/patient, via a written list, the types, amounts, and method of administration of nutritionalsupplements to use in addition to foods, in order to achieve optimum nutrient intake and utilization.PERFORMANCE DOMAIN III: DETOXIFICATION, HERBOLOGYAND HOMEOPATHIC THERAPY - PGSCN SESSION IIIKnowledges: Knowledge of Human Toxicity.Knowledge of Bowel Terrain.Knowledge of toxic conditions, allergies and sensitivities.Knowledge of requirements needed for detoxification.Knowledge of Therapy Modality; Homeopathy, Phytotherapy.Knowledge of Therapy Modality; Herbology.Knowledge of limitations of research results.Knowledge of counseling using Alternative Therapies and Clinical Nutrition.EXAM TEXT BOOK STUDYQuick Access: Professional Guide to Conditions, Herbs and Supplements. Publisher: Integrative MedicineISBN# 0-9670-7725-7 Knowledge of metabolic intermediates as nutrients, and their roles and actions (e.g., coenzyme Q10).Knowledge of pertinent clinical blood, serum, or plasma tests (will include chemistries, hematology, serology,immunology, etc.).Knowledge of effects of deviation from normal metabolic, physical, bioelectrical and case historical findingson nutritional status.2019 CNCB. All rights reservedPage 6

Knowledge of physical signs of abnormal endocrine and neurologic functions.Knowledge of the amounts and types of supplemental nutrients that have been found beneficial for variousdiseases.Knowledge of the interactions between nutrients.Knowledge of uses, effects, toxicities, and suitability of botanicals as nutritional supplements.EXAM TEXT BOOK STUDYThe Complete Homeopathic Resource for Common Illness. Chernin Publisher: N. Atlantic BooksISBN# 1-5564-3-608-4 Basic knowledge of vitamins, including the fat soluble vitamins (A, D, E, and K), the water soluble, and the Bvitamins.Knowledge of physical signs of abnormal endocrine and neurologic functions.Knowledge of physical signs of abnormal musculoskeletal, integumentary, and connective tissue function.Knowledge of official homeopathic remedies, their uses, effects, manufacture, and suitability as nutritionalsupplements.PERFORMANCE DOMAIN IV: LABORATORY ASSESSMENT – PGSCN SESSION IVKnowledges: Knowledge of the rationale needed for Laboratory Assessment.Knowledge of Vitamins as related to Enzymes.Knowledge of Mineral Laboratory Testing.Knowledge of Amino Acid Laboratory Testing.Knowledge of Fatty Acid Laboratory Testing.Knowledge of Organic Acid Laboratory Testing.Knowledge of Gastrointestinal Disorder Laboratory Testing.o Digestion & Absorption Testingo Microbial Flora Testingo Gastric and Pancreatic Function Testing.o Intestinal Function & Permeability.o Leaky Gut Syndrome.o Dysbiosiso Bacterial & Protozoal Markerso Food Allergy & Test Results.Knowledge of Detoxification Testing.o Urinary MarkersKnowledge of Hormones and Laboratory TestingKnowledge of Aging and Oxidant Stress Testing.Knowledge of Urinary Metabolic Markers.Knowledge of Case Reports and Case Outcomes.EXAM TEXT BOOK STUDYThe Basic 100. Queen, H.L.For ordering contact Betty Queen 407-566-1276 BAQueen@Designed2Win.com2019 CNCB. All rights reservedPage 7

CERTIFIED CLINICAL NUTRITIONIST (CCN)EXAMINATION REFERENCE TEXT LISTAs listed within the above Domains I-IVChernin. The Complete Homeopathic Resource for Common Illness. Publisher: N. AtlanticBooks ISBN# 1-5564-3-608-4Integrative Medicine. Quick Access: Professional Guide to Conditions, Herbs andSupplements. Publisher: Integrative Medicine ISBN# 0-9670-7725-7Queen, H.L. The Basic 100. Contact Betty Queen Discount available after Credential Review application isapproved, contact Adrenal Fatigue: The 21st Century Stress Syndrome. Publisher: Smart PublicationsISBN# 1-890572-15-22019 CNCB. All rights reservedPage 8

CCN Practice Quiz1.A.B.C.D.Which of the essential amino acids is a precursor for the production of .B.C.D.Which air ions have the greatest positive health benefit?Negative ionsPositive ionsDivalent ionsNeutral ions3.A.B.C.D.Diabetic individuals who are taking a biguanide medication may developOsteoporosisAn inability to convert tryptophan to serotoninKidney stonesA permanent inability to absorb vitamin B124.A.B.C.D.Wilson's disease is a condition characterized by elevated levels ofLeadChromiumCopperMercury5.A.B.C.D.Studies report that conjugated linoleic acid (CLA) may be helpful forWeight lossLowering blood pressureImproving insomniaElevating depression6.A.B.C.D.On a world-wide basis, one of the most severe consequences of vitamin A deficiency is?Childhood deaths from nyctalopiaChildhood deaths from malariaChildhood deaths from diarrheaChildhood deaths from measles7.A.B.C.D.The neutrophilic hyper-segmentation index is a lab test to measure25-hydroxy vitamin D levelsVitamin B6 levelsVitamin B12 levelsFolic acid levels8.A.B.C.D.Oral contraceptive users who take additional daily calcium supplements mayDevelop orthostatic hypotensionBe at increased risk for blood clotsDevelop insomniaDevelop cervical dysplasia2019 CNCB. All rights reservedPage 9

9. Which of the following nutrients is depleted by both major classes of oral hypoglycemicdrugs?A. Coenzyme Q10B. Vitamin B1C. Vitamin B6D. Magnesium10.A.B.C.D.Digestion of which class of macronutrients is likely to be impaired by anti-ulcer B.C.D.What other factor(s) than genetics predispose the health history of the unborn child?Hygiene, Dietary factors and StressHygiene, Dietary factors, Maternal Endotoxins, Stress and Genetic loadDietary factors, Maternal Endotoxins and StressMaternal Endotoxins and Genetic load12.A.B.C.D.Conditions that might benefit from toxic load reduction are:Allergies, Headaches, Joint pain and FatigueAllergies and HeadachesAllergies, Headaches, Joint pain, Fatigue and Poor memoryAllergies and Joint pain13.A.B.C.D.Bowel Terrain enhancement may be achieved by the use of .Antioxidants and Digestive enzymesProanthocyanidinsGlutamine and FOS, Antioxidants, Caprylic Acid, Digestive enzymes and ProanthocyanidinsGlutamine and FOS and Antioxidants14.A.B.C.D.Which complaint(s) suggest the therapeutic investigation of detoxification?Headaches and Low back painJoint pain, Gastrointestinal distress and Low back painJoint pain, Gastrointestinal distress, Poor memory and HeadachesLow back pain15.A.B.C.Kidney stone formation is said to be inhibited by ingestion of which nutrient(s).B6 , Magnesium Citrate and Magnesium OrotateB6Magnesium Citrate, Magnesium Aspartate, Magnesium Oxide and Magnesium OrotateD. B6, Magnesium Citrate, Magnesium Aspartate and Magnesium Oxide16. Which of the following lab values might NOT be present in a patient presenting ironanemia?A. Normal red blood cell countB. High serum or red blood cell ferritinC. Low red blood cell countD. High or high normal red blood cell distribution widthE. Low or low normal serum iron2019 CNCB. All rights reservedPage 10

17. What is the most efficient and easiest way to evaluate melatonin levels?A. Salivary testing morning, evening and midnightB. Radio immune assay using plasmaC. Pineal biopsyD. Urinary indole 3 carbinolE. Slit lamp ophthalmological testing18. What is the best measure for long-term glucose control?A. HemoglobinB. 24 hour urine glucoseC. Finger stickD. Erythrocyte glucose 6 phosphataseE. Fructosamine19. Which method of testing gives an overall body burden of mercury?A. Spot testing of urine for mercury levels, first morning void.B. Provocation testing taken prior to urinary collection of 6 or 24 hours.C. 24 hour urine collection for mercury levelsD. Hair or toe nail clipping analysis, void of environmental contaminateE. Blood levels for mercury levels and or erythrocyte.20. What in the brain controls extracellular glutamate levels?A. Interaction with selenomethionineB. Elimination by the kidneyC. Glutamate TransportersD. Metabolic conversion to serotoninE. Redox inactivation within neurons21. Which form of hydroxyestrogen is associated with an increased risk of breast andprostate cancer?A. EstriolB. EstroneC. DHEAD. EstradiolE. 16-hydroxyestrogen22. What is an effective test for occult infection?A.

CNCB Scientific Council collects statistics about the performance of CCN Certification Examination questions as they are used on the examination. Referred to as item analysis, CNCB Scientific Council evaluates the difficulty of the question, the degree to which the question discriminates between knowledgeable and unknowledgeable candidates, and

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